I am fortunate enough to count Professor Jonathan Glover, a world renowned medical ethicist, amongst my former teachers. A very modest and thoughtful man, Jonathan Glover spent a number of years writing a similarly thoughtful book in which he tries to understand what he terms man’s inhumanity to man (Humanity: a Moral History of the Twentieth Century. Pimlico, London 2001). His starting premise is that, given the wrong circumstances, we are all capable of doing evil things to other human beings. At the heart of his efforts are a desire to understand, for all our sakes, what it  has taken in the past, and by extension what it would take in the future, for people- just like you and me- to be willing to take part in our own equivalent of the Holocaust and the Rwandan genocide.

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There are always, within the population, individuals who have no one to collect medicines for them when they are ill. The group predominantly affected are the elderly but, especially in a situation in which a significant proportion of the population is affected by a flu pandemic, there will be others. In normal circumstances we have a tried and trusted system of asking local pharmacies to deliver medications, including emergency medications, to people’s homes. more…

Over the weekend, mixed with the harrowing coverage of the loss of soldiers’ lives in Afghanistan, and for news cycle reasons I’ve inadequate information to understand, the fate of London’s homeless population prior to the 2012 Olympics was discussed on television and in print. The organising committee of the London Games had apparently committed itself to ensuring that no one would be sleeping rough on London’s streets by the time the world’s elite athletes arrived. The question of the weekend was whether this goal would be achieved and at what price, both economic and in terms of human dignity. more…

If you want to refresh your memory of the comings and goings in Geroge Eliot’s classic, Middlemarch, then look no further than Professor Rosin’s analysis in the June 2009 issue of Medical Humanities.

http://mh.bmj.com/cgi/content/short/35/1/43?q=w_mh_current_tab

If you want to follow a contemporary equivalent of medical marketplace machinations then you need look no further than what is currently happening to general practice in England and Wales. And specifically to the Orwellian world in which carers and cared for find themselves. A world where government announcements to the national news media of the universal introduction of Cognitive Behavioural Therapy are followed by the systematic reduction of mental health care services in primary care. In my own practice, in the past 6 months, first the PCT provided mental health care worker was removed and more recently the practice counsellor of 17 years standing was ‘let go’. But hey ho, never mind, NICE guidance has after all told us what to do: if a patient is suitable for CBT and it isn’t available (!) we can (and should) tell them to ‘hang on’. more…

Half a lifetime ago I went to Australia for my medical elective, a joyous interlude just before finals that allows doctors-to-be to savour, for one last time, the freedom of life as a student. Eight weeks is barely time to get over the jetlag let alone to adjust to the stark and breathtaking landscapes that unfurl in any journey across this large and mystifying country. Yet long enough to leave the lasting impression that no matter how impressive the delights of Sydney and Melbourne and Australia’s other cities and towns, this is a country only a blink away from submission to its own awesome forces of nature.

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Albert Camus argued that anyone who chooses life over death is an absurd hero. Absurd because Camus could see no logical reason why anyone would choose the pain and suffering that living even the most blessed of lives entails when ultimately the struggle to stay alive will surely fail. And heroic because, in full knowledge of this truth, and in full knowledge of the burden of pain and loss that staying alive will inevitably entail, a person who chooses life and not death somehow finds the courage to make that choice. more…

So how are you coping? Are you managing to make the right choices in these difficult times? And what if you make the wrong decision? Do you worry you might be sued, or worse still that the care people receive will suffer? And no, I’m not talking about the stresses and strains of clinical practice, pressing as these can be in an ever litigious society. Nor am I referring to widespread anxieties about rising unemployment, including medical. Instead I’m talking about the admittedly niche ethics angst that is part and parcel of a modern journal editor’s lot. more…

Helen Garner’s The Spare Room (published by Canongate) is an exploration of the emotional and practical turmoil engendered by caring for someone who is grasping at straws to evade the terminal truth of their illness.

The narrative probes a friendship between two feisty women when it is taken to new levels of intensity by a clash in ideology. Helen (who deliberately shares the author’s name) starts off with noble intentions. She prepares her spare room with due consideration for longstanding-friend Nicola’s feng shui inclinations, hoping to strike just the right balance between practicality and homeliness. Nicola, riven with cancer, is coming to Sydney to spend a small fortune on alternative therapy at the Theodore Institute. Predictably, the Institute proves fantastically adept at sales talk but medically deeply dubious. Nicola emerges from intravenous Vitamin C treatment and ozone cupping weakened and wracked with excruciating pain, but she holds out against morphine until she – and, more particularly, Helen – can bear it no longer. Nicola is coaxed into reengaging with orthodox medicine by her outraged and exhausted friend. more…

The other day I made a call to our local hospital to ask a colleague to see a patient of mine as a matter of urgency. I asked the switchboard operator to page the relevant on-call registrar who duly appeared on the other end of the line. Using “hello?” as his tense, inpatient, opening gambit wasn’t a good start. more…

http://www.fox.com/house/gallery/

Back in the mid-80s when, as a junior doctor, I went to work in the US, I caused a mini-panic amongst the nurses by refusing, at least for a short while, to sign “MD” after my orders. An order in this context being a written order to the nurses to do the myriad of small and big things that comprising the nurse-delivered medical care of a patient. The reason for my reluctance to sign myself MD was that, in England, an MD was a person who had undertaken clinical research, written a thesis, and had subsequently been awarded a medical doctorate. By contrast, MD written after a person’s name in the US simply means that that the person is medically qualified. more…